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Faith L, Wiesepape C, Kukla M, Lysaker P. Promoting Meaning and Recovery for Psychosis: Comparison of Metacognitively-Oriented Psychotherapists and Clinicians in Psychiatric Rehabilitation. Neuropsychiatr Dis Treat 2023; 19:2179-2194. [PMID: 37873532 PMCID: PMC10590553 DOI: 10.2147/ndt.s386004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Accepted: 10/06/2023] [Indexed: 10/25/2023] Open
Abstract
Introduction Recovery from psychosis is an expected and desired outcome in psychiatric rehabilitation that may involve subjective outcomes related to personal recovery. While a considerable amount of qualitative research has examined patients' experience of recovery oriented approaches, there are less studies examining clinicians' perspectives. Examining the clinician point of view is important for both supporting clinicians within recovery-oriented practice, as well as for understanding underlying therapeutic processes. The aims of this study were to explore clinician experience of offering different psychiatric rehabilitation treatments for individuals with psychosis, and to understand similarities and differences of clinicians whose work differed in its recovery emphasis. Methods Open-ended interviews were conducted with 10 psychotherapists providing Metacognitive Reflection and Insight Therapy (MERIT), a recovery oriented form of integrative psychotherapy focused on subjective aspects of recovery, and 10 clinicians providing standard psychiatric rehabilitation services. Results Thematic analysis revealed important similarities and differences between these two groups of providers. There were seven themes found for MERIT therapists: Comfort with uncertainty, Emphasis on collaboration, Being part of therapeutic change, Connecting with clients, Emphasis on patient autonomy, Experiencing growth, and Therapist use of self-awareness. There were four themes found for psychiatric rehabilitation clinicians: Value of a structured approach, Focus on a strengths-based approach, Witnessing behavioral change, and Building rapport to support the work. Discussion As expected, both similarities and differences arose between clinician groups. Results indicated that both groups focused on the therapeutic relationship and monitoring progress and outcomes. Unexpectedly, MERIT therapists reported growth as well as comfort with uncertainty. These findings suggest that MERIT is a a psychotherapy that offers unique opportunities for creative and flexible exploration of meaning and agency that is both challenging and rewarding for clinicians. Implications for supporting healthy clinician practice and the development of services are discussed.
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Affiliation(s)
- Laura Faith
- Department of Psychiatry, Richard L Roudebush VA Medical Center, Indianapolis, IN, USA
| | - Courtney Wiesepape
- Department of Psychiatry, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Marina Kukla
- HSR&D Center for Health Information and Communication, Richard L Roudebush VA Medical Center, Indianapolis, IN, USA
- Department of Psychology, Indiana University-Purdue University Indianapolis, Indianapolis, IN, USA
| | - Paul Lysaker
- Department of Psychiatry, Richard L Roudebush VA Medical Center, Indianapolis, IN, USA
- Department of Psychiatry, Indiana University School of Medicine, Indianapolis, IN, USA
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Martin S. Why using “consciousness” in psychotherapy? Insight, metacognition and self-consciousness. NEW IDEAS IN PSYCHOLOGY 2023. [DOI: 10.1016/j.newideapsych.2023.101015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/31/2023]
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Promoting Affect Regulation Among Individuals Experiencing Psychosis in Metacognitive Reflection and Insight Therapy (MERIT). JOURNAL OF CONTEMPORARY PSYCHOTHERAPY 2023. [DOI: 10.1007/s10879-022-09570-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
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Martiadis V, Pessina E, Raffone F, Iniziato V, Martini A, Scognamiglio P. Metacognition in schizophrenia: A practical overview of psychometric metacognition assessment tools for researchers and clinicians. Front Psychiatry 2023; 14:1155321. [PMID: 37124248 PMCID: PMC10133516 DOI: 10.3389/fpsyt.2023.1155321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Accepted: 03/29/2023] [Indexed: 05/02/2023] Open
Abstract
Metacognition refers to the cognitive ability to control, monitor and modulate cognitive processes thus guiding and orienting behavior: a continuum of mental activities that ranges from more discrete ones, such as the awareness of the accuracy of others' judgment, to more integrated activities, such as the knowledge of cognitive processes. Metacognition impairment in schizophrenia, which is considered a core feature of the illness, has become a growing research field focusing on a wide range of processes including reasoning, autobiographical memory, memory biases, cognitive beliefs and clinical insight. There is a well-established relationship between metacognition and schizophrenia symptoms severity, as well as between impaired metacognitive functioning and specific symptomatic sub-domains, such as positive symptoms, negative symptoms, or disorganization. The development of specific cognitive-derived psychotherapies for metacognitive deficits in schizophrenia has been ongoing in the last years. Although sharing a metacognitive feature, these treatments focus on different aspects: false or unhelpful beliefs for metacognitive therapy; cognitive biases for metacognitive training; schematic dysfunctional beliefs for cognitive behavioral therapy (CBT) for psychoses; metacognitive knowledge and sense of identity for MERIT; interpersonal ideas or events triggering delusional thinking for MIT-P. This article reviews the instruments designed to assess metacognitive domains and functions in individuals with schizophrenia, providing mental health professionals with an overview of the heterogeneous current scenario ranging from self-administered scales to semi-structured interviews, which are supported by a variety of theoretical frameworks. Future directions may address the need for more specific and refined tools, also able to follow-up psychotherapeutic-induced improvements.
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Affiliation(s)
- Vassilis Martiadis
- Department of Mental Health, Community Mental Health Center DS 25, ASL Napoli 1 Centro, Naples, Italy
- *Correspondence: Vassilis Martiadis,
| | - Enrico Pessina
- Department of Mental Health, Community Mental Health Center, ASL Cuneo 2, Alba, Italy
| | - Fabiola Raffone
- Department of Mental Health, Community Mental Health Center DS 25, ASL Napoli 1 Centro, Naples, Italy
| | - Valeria Iniziato
- Department of Mental Health, Community Mental Health Center DS 32, ASL Napoli 1 Centro, Naples, Italy
| | - Azzurra Martini
- Department of Mental Health, Community Mental Health Center, ASL Cuneo 2, Alba, Italy
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Igra L, Sened H, Lavi-Rotenberg A, Pijnenborg M, Lysaker PH, Hasson-Ohayon I. Emotional experience and metacognition among people with schizophrenia: Analysis of session by session and outcome of metacognitive-oriented psychotherapy. J Psychiatr Res 2022; 156:460-466. [PMID: 36335836 DOI: 10.1016/j.jpsychires.2022.10.048] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2022] [Revised: 09/18/2022] [Accepted: 10/17/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND Research suggests that in-session emotional experiences in psychotherapy promote both session and treatment outcomes across different clinical samples and treatment approaches. However, little is known about how this notion applies to clients with schizophrenia, who experience particular deficits related to emotional experience. To explore this question, we investigated the association between clients' emotional experience and their session outcome evaluations and metacognitive growth in a metacognitively-oriented treatment, Metacognitive Reflection and Insight Therapy (MERIT). MERIT is a recovery-oriented treatment approach for psychosis that focuses on recapturing a coherent sense of self and personal agency by enhancing metacognitive capacity. METHOD Five-hundred-and-sixty-three sessions of 37 clients with schizophrenia who took part in an ongoing MERIT trial were analyzed. The Emotional Experience Self-Report (EE-SR) and Outcome Rating Scale (ORS) were collected on a session-by-session basis. Levels of metacognition ware assessed pre- and post-treatment using the Metacognitive Assessment Scale-Abbreviated (MAS-A) coding system. We used multilevel modeling to test our session-level predictions, and linear regression analysis for treatment-level predictions. RESULTS Greater emotional experience, expression, and regulation within a session were associated with better session outcome. Regarding treatment level, greater emotional experience was associated with improvement in metacognitive mastery. CONCLUSIONS Our findings reveal that experiencing emotions in MERIT has significant implications for clients' subjective well-being during therapy sessions and for their ability to respond to psychological challenges using metacognitive knowledge. These findings lend weight to the idea that emotional experience is a key mechanism of change in metacognitive therapy for schizophrenia.
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Affiliation(s)
- Libby Igra
- Department of Psychology, Bar-Ilan University, Ramat Gan, Israel.
| | - Haran Sened
- Department of Psychology, University of Haifa, Haifa, Israel
| | | | - Marieke Pijnenborg
- Department of Clinical Psychology and Experimental Psychopathology, University of Groningen, the Netherlands
| | - Paul H Lysaker
- Department of Psychiatry, Richard L. Roudebush VA Medical Center, Indianapolis, IN, USA; Department of Psychiatry, Indiana University School of Medicine, Indianapolis, IN, USA
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Lavi-Rotenberg A, Roe D, Asher M, Hasson-Ohayon I. A Qualitative Evaluation of the Effects of Social Cognition and Interaction Training (SCIT) Versus Therapeutic Alliance Focused Therapy (TAFT) Among Persons With Serious Mental Illness. Int J Ment Health Addict 2021. [DOI: 10.1007/s11469-021-00665-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Lysaker PH, Cheli S, Dimaggio G, Buck B, Bonfils KA, Huling K, Wiesepape C, Lysaker JT. Metacognition, social cognition, and mentalizing in psychosis: are these distinct constructs when it comes to subjective experience or are we just splitting hairs? BMC Psychiatry 2021; 21:329. [PMID: 34215225 PMCID: PMC8254212 DOI: 10.1186/s12888-021-03338-4] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Accepted: 06/21/2021] [Indexed: 02/01/2023] Open
Abstract
Research using the integrated model of metacognition has suggested that the construct of metacognition could quantify the spectrum of activities that, if impaired, might cause many of the subjective disturbances found in psychosis. Research on social cognition and mentalizing in psychosis, however, has also pointed to underlying deficits in how persons make sense of their experience of themselves and others. To explore the question of whether metacognitive research in psychosis offers unique insight in the midst of these other two emerging fields, we have offered a review of the constructs and research from each field. Following that summary, we discuss ways in which research on metacognition may be distinguished from research on social cognition and mentalizing in three broad categories: (1) experimental procedures, (2) theoretical advances, and (3) clinical applications or indicated interventions. In terms of its research methods, we will describe how metacognition makes a unique contribution to understanding disturbances in how persons make sense of and interpret their own experiences within the flow of life. We will next discuss how metacognitive research in psychosis uniquely describes an architecture which when compromised - as often occurs in psychosis - results in the loss of persons' sense of purpose, possibilities, place in the world and cohesiveness of self. Turning to clinical issues, we explore how metacognitive research offers an operational model of the architecture which if repaired or restored should promote the recovery of a coherent sense of self and others in psychosis. Finally, we discuss the concrete implications of this for recovery-oriented treatment for psychosis as well as the need for further research on the commonalities of these approaches.
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Affiliation(s)
- P H Lysaker
- Richard L Roudebush VA Medical Center, Department of Psychiatry, 1481 W. 10th St., Indianapolis, IN, 46202, USA. .,Department of Psychiatry, Indiana University School of Medicine, 340 W. 10th St., Indianapolis, IN, 46202, USA.
| | - S Cheli
- University of Florence, School of Human Health Sciences, Piazza di San Marco, 4, 50121, Florence, FI, Italy
| | - G Dimaggio
- Terzocentro di Psicoterapia Cognitiva, Associazione di Psicologia Cognitiva, Via Ravenna, 9, 00161, Rome, RM, Italy
| | - B Buck
- Department of Psychiatry and Behavioral Sciences, University of Washington, Behavioral Research in Technology and Engineering (BRiTE) Center, 1851 NE Grant Ln., Seattle, WA, 98185, USA
| | - K A Bonfils
- University of Southern Mississippi, School of Psychology, 118 College Dr., Hattiesbury, MS, 39406, USA
| | - K Huling
- University of Indianapolis, School of Psychological Sciences, 1400 E. Hanna Ave., Indianapolis, IN, 46277, USA
| | - C Wiesepape
- Indiana State University, Department of Psychology, 200 N. 7th St., Terre Haute, IN, 47809, USA
| | - J T Lysaker
- Department of Philosophy, Emory University, 201 Dowman Dr., Atlanta, GA, 30322, USA
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van der Meer L, Jonker T, Wadman H, Wunderink C, van Weeghel J, Pijnenborg GHM, van Setten ERH. Targeting Personal Recovery of People With Complex Mental Health Needs: The Development of a Psychosocial Intervention Through User-Centered Design. Front Psychiatry 2021; 12:635514. [PMID: 33897494 PMCID: PMC8060492 DOI: 10.3389/fpsyt.2021.635514] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Accepted: 01/25/2021] [Indexed: 12/21/2022] Open
Abstract
Long-term admissions in psychiatric facilities often result in a gradual erosion of the identity of people diagnosed with severe mental illnesses (SMIs) into merely "patient." Moreover, experiences of loss often reduced people's sense of purpose. Although regaining a multidimensional identity and a sense of purpose are essential for personal recovery, few interventions specifically address this, while at the same time take people's often considerable cognitive and communicative disabilities into consideration. This study describes the development process of a new intervention through user-centered design (UCD). UCD is an iterative process in which a product (in this case, an intervention) is developed in close cooperation with future users, such that the final product matches their needs. The design process included three phases: an analysis, design, and evaluation phase. In the analysis phase, the "problem" was defined, users' needs were identified, and design criteria were established. In the design phase, the collected information served as input to create a testable prototype using a process of design and redesign, in close collaboration with service users and other stakeholders. This resulted in an intervention entitled "This is Me" (TiM) in which service users, together with a self-chosen teammate, actively engage in new experiences on which they are prompted to reflect. Finally, in the evaluation phase, TiM was implemented and evaluated in a real-life setting. In a small feasibility pilot, we found indications that some people indeed demonstrated increased reflection on their identity during the intervention. Furthermore, TiM seemed to benefit the relationship between the service users and the mental health professionals with whom they underwent the experiences. The pilot also revealed some aspects of the (implementation of) TiM that can be improved. Overall, we conclude that UCD is a useful method for the development of a new psychosocial intervention. The method additionally increased our knowledge about necessary factors in targeting personal recovery for people with complex mental health needs. Moreover, we conclude that TiM is a promising tool for supporting people with SMI in redeveloping a multidimensional identity and a renewed sense of purpose.
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Affiliation(s)
- Lisette van der Meer
- Department of Rehabilitation, Lentis Center for Mental Health Care, Zuidlaren, Netherlands.,Department of Clinical and Developmental Neuropsychology, University of Groningen, Groningen, Netherlands
| | - Tessa Jonker
- Department of Rehabilitation, Lentis Center for Mental Health Care, Zuidlaren, Netherlands
| | - Heleen Wadman
- BuurtzorgT Mental Health Institution, Groningen, Netherlands
| | - Charlotte Wunderink
- Department of Rehabilitation, Lentis Center for Mental Health Care, Zuidlaren, Netherlands.,Research and Innovation Center for Rehabilitation, Hanze University of Applied Sciences, Groningen, Netherlands
| | - Jaap van Weeghel
- Department of TRANZO, Tilburg School of Social and Behavioral Sciences, Tilburg University, Tilburg, Netherlands.,Parnassia Group, Parnassia Noord Holland, Castricum, Netherlands.,Phrenos Center of Expertise on Severe Mental Illness, Utrecht, Netherlands
| | - Gerdina Hendrika Maria Pijnenborg
- Department of Clinical Psychology and Experimental Psychopathology, University of Groningen, Groningen, Netherlands.,Department of Psychotic Disorders, GGZ-Drenthe, Assen, Netherlands
| | - Ellie R H van Setten
- Department of Rehabilitation, Lentis Center for Mental Health Care, Zuidlaren, Netherlands.,Rob Giel Research Center, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
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9
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Hasson-Ohayon I, Lysaker PH. Special challenges in psychotherapy continuation and adaption for persons with schizophrenia in the age of coronavirus (COVID-19). COUNSELLING PSYCHOLOGY QUARTERLY 2020. [DOI: 10.1080/09515070.2020.1781595] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Affiliation(s)
| | - Paul H. Lysaker
- Department of Psychiatry, Roudebush, VA Medical Center, USA
- Department of Psychiatry, Indiana University School of Medicine, Indianapolis, USA
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10
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Moritz S, Klein JP, Lysaker PH, Mehl S. Metacognitive and cognitive-behavioral interventions for psychosis: new developments
. DIALOGUES IN CLINICAL NEUROSCIENCE 2020; 21:309-317. [PMID: 31749655 PMCID: PMC6829173 DOI: 10.31887/dcns.2019.21.3/smoritz] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
This review describes four cognitive approaches for the treatment of
schizophrenia: cognitive-behavioral therapy for psychosis (CBTp), metacognitive therapy,
metacognitive training, and metacognitive reflection insight therapy (MERIT). A central
reference point of our review is a seminal paper by James Flavell, who introduced the
term metacognition (“cognition about cognition”). In a way, every psychotherapeutic
approach adopts a metacognitive perspective when therapists reflect with clients about
their thoughts. Yet, the four approaches map onto different components of metacognition.
CBTp conveys some “metacognitive knowledge” (eg, thoughts are not facts) but is mainly
concerned with individual beliefs. Metacognitive therapy focuses on unhelpful
metacognitive beliefs about thinking styles (eg, thought suppression). Metacognitive
training brings distorted cognitive biases to the awareness of patients; a central goal
is the reduction of overconfidence. MERIT focuses on larger senses of identity and
highlights metacognitive knowledge about oneself and other persons. For CBTp and
metacognitive training, meta-analytic evidence supports their efficacy; single studies
speak for the effectiveness of MERIT and metacognitive therapy.
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Affiliation(s)
- Steffen Moritz
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Jan Philipp Klein
- Department of Psychiatry and Psychotherapy, Lübeck University, Lübeck, Germany
| | - Paul H Lysaker
- Department of Psychiatry, Roudebush VA Medical Center, Indiana University School of Medicine, Indianapolis, IN, US
| | - Stephanie Mehl
- Department of Psychiatry and Psychotherapy, Philipps-University Marburg, Germany;
Department of Health and Social Work, Frankfurt University of Applied Science Frankfurt, Germany
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Lysaker PH, Gagen E, Klion R, Zalzala A, Vohs J, Faith LA, Leonhardt B, Hamm J, Hasson-Ohayon I. Metacognitive Reflection and Insight Therapy: A Recovery-Oriented Treatment Approach for Psychosis. Psychol Res Behav Manag 2020; 13:331-341. [PMID: 32308511 PMCID: PMC7135118 DOI: 10.2147/prbm.s198628] [Citation(s) in RCA: 46] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Accepted: 02/15/2020] [Indexed: 12/18/2022] Open
Abstract
Recent research has suggested that recovery from psychosis is a complex process that involves recapturing a coherent sense of self and personal agency. This poses important challenges to existing treatment models. While current evidence-based practices are designed to ameliorate symptoms and skill deficits, they are less able to address issues of subjectivity and self-experience. In this paper, we present Metacognitive Insight and Reflection Therapy (MERIT), a treatment approach that is explicitly concerned with self-experience in psychosis. This approach uses the term metacognition to describe those cognitive processes that underpin self-experience and posits that addressing metacognitive deficits will aid persons diagnosed with psychosis in making sense of the challenges they face and deciding how to effectively manage them. This review will first explore the conceptualization of psychosis as the interruption of a life and how persons experience themselves, and then discuss in more depth the construct of metacognition. We will next examine the background, practices and evidence supporting MERIT. This will be followed by a discussion of how MERIT overlaps with other emerging treatments as well as how it differs. MERIT's capacity to engage patients who reject the idea that they have mental illness as well as cope with entrenched illness identities is highlighted. Finally, limitations and directions for future research are discussed.
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Affiliation(s)
- Paul H Lysaker
- Richard L. Roudebush VA Medical Center, Indianapolis, IN, USA
- Indiana University School of Medicine, Indianapolis, IN, USA
| | - Emily Gagen
- Providence VA Medical Center Department of Psychology, Providence, RI, USA
| | | | | | - Jenifer Vohs
- Indiana University School of Medicine, Indianapolis, IN, USA
| | - Laura A Faith
- Richard L. Roudebush VA Medical Center, Indianapolis, IN, USA
- University of Missouri - Kansas City, KS, USA
| | - Bethany Leonhardt
- Indiana University School of Medicine, Indianapolis, IN, USA
- Eskenazi Health- Midtown Community Mental Health, Indianapolis, IN, USA
| | - Jay Hamm
- Eskenazi Health- Midtown Community Mental Health, Indianapolis, IN, USA
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12
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Supervision in the Psychotherapy of Schizophrenia: Awareness of and Mutual Reflection upon Fragmentation. Am J Psychoanal 2019; 79:284-303. [PMID: 31332242 DOI: 10.1057/s11231-019-09198-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Historical and newly emerging models of schizophrenia suggest it is a disorder characterized by the fragmentation of the experience of the self and the world, leading to the interruption of how a unique life is unfolding in the world. It has been proposed that psychotherapy might therefore promote recovery by facilitating the development of a greater ability to integrate information about the self and others. In this paper we explore how the supervision of a metacognitively-oriented psychotherapy can assist therapists to experience and conceptualize fragmentation within sessions, join patients in the gradual process of making sense of their psychiatric problems and life challenges, and ultimately envision and achieve recovery. Common challenges and responses within supervision are described and discussed.
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13
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de Jong S, Hasson-Ohayon I, van Donkersgoed RJM, Timmerman ME, van der Gaag M, Aleman A, Marieke Pijnenborg GH, Lysaker PH. Predicting therapy success from the outset: The moderating effect of insight into the illness on metacognitive psychotherapy outcome among persons with schizophrenia. Clin Psychol Psychother 2019; 26:650-660. [PMID: 31270887 DOI: 10.1002/cpp.2388] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2018] [Revised: 03/20/2019] [Accepted: 05/13/2019] [Indexed: 12/16/2022]
Abstract
The degree to which a person recognizes their mental disorder, attributes symptoms to the disorder, and recognizes that treatment may be necessary is frequently referred to as clinical insight. The current study investigates whether clinical insight at baseline moderates the effects on metacognitive capacity of 40 sessions of metacognitive reflection and insight therapy among 35 participants with psychosis. Findings showed that clinical insight did not predict drop-out from therapy. Multilevel analyses provided support for our hypotheses that insight at baseline significantly moderates metacognitive gains at both postmeasurement and follow-up. Our findings demonstrate that lacking clinical insight substantially hampers the effect of this psychosocial intervention. We posit that research efforts should shift from developing interventions, which enhance clinical insight, to interventions, which are effective in absence of clinical insight.
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Affiliation(s)
| | | | | | - Marieke E Timmerman
- Psychometrics and Statistics, University of Groningen, Groningen, The Netherlands
| | - Mark van der Gaag
- Psychosis Research, Parnassia Psychiatric Institute, The Netherlands.,Department of Clinical Psychology and Amsterdam Public Health Research, VU University, Amsterdam, The Netherlands
| | - Andre Aleman
- Department of Neuroscience, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.,Department of Clinical Psychology and Experimental Psychopathology, University of Groningen, Groningen, The Netherlands
| | - G H Marieke Pijnenborg
- Department of Clinical Psychology and Experimental Psychopathology, University of Groningen, Groningen, The Netherlands.,Department of Psychotic Disorders, GGZ Noord-Drenthe, Assen, The Netherlands
| | - Paul H Lysaker
- Department of Psychiatry, Roudeboush VA Medical Center, Indianapolis, IN, USA.,Department of Psychiatry, Indiana University School of Medicine, Indianapolis, IN, USA
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Lysaker PH, Minor KS, Lysaker JT, Hasson-Ohayon I, Bonfils K, Hochheiser J, Vohs JL. Metacognitive function and fragmentation in schizophrenia: Relationship to cognition, self-experience and developing treatments. SCHIZOPHRENIA RESEARCH-COGNITION 2019; 19:100142. [PMID: 31828019 PMCID: PMC6889776 DOI: 10.1016/j.scog.2019.100142] [Citation(s) in RCA: 52] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/30/2018] [Revised: 03/13/2019] [Accepted: 03/25/2019] [Indexed: 12/26/2022]
Abstract
Bleuler suggested that fragmentation of thought, emotion and volition were the unifying feature of the disorders he termed schizophrenia. In this paper we review research seeking to measure some of the aspects of fragmentation related to the experience of the self and others described by Bleuler. We focus on work which uses the concept of metacognition to characterize and quantify alterations or decrements in the processes by which fragments or pieces of information are integrated into a coherent sense of self and others. We describe the rationale and support for one method for quantifying metacognition and its potential to study the fragmentation of a person's sense of themselves, others and the relative place of themselves and others in the larger human community. We summarize research using that method which suggests that deficits in metacognition commonly occur in schizophrenia and are related to basic neurobiological indices of brain functioning. We also present findings indicating that the capacity for metacognition in schizophrenia is positively related to a broad range of aspects of psychological and social functioning when measured concurrently and prospectively. Finally, we discuss the evolution and study of one therapy that targets metacognitive capacity, Metacognitive Reflection and Insight Therapy (MERIT) and its potential to treat fragmentation and promote recovery.
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Affiliation(s)
- Paul H Lysaker
- Roudebush Veteran Affairs Medical Center, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Kyle S Minor
- Indiana University-Purdue University at Indianapolis, Indianapolis, IN, USA
| | | | | | - Kelsey Bonfils
- VA Pittsburgh Healthcare System, Mental Illness Research, Education, & Clinical Center (MIRECC), Pittsburgh, PA, USA.,Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, USA
| | | | - Jenifer L Vohs
- Indiana University School of Medicine, Indianapolis, IN, USA
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